AAO-HNS Advocacy Tools to Support Your Practice

Jacob Manthey, MBA, MsHCM, Director, Health Policy & Practice Advocacy, Ana Maria Grady, MD, Senior Manager, Economic Health Policy & Advocacy, and Anna Hall, Manager, Health Policy & Regulatory Affairs

The American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) Health Policy Advocacy team works in partnership with the Academy's Physician Payment Policy (3P) Workgroup, physician leaders, and Academy staff to provide support regarding physician payment and covered services. The team identifies challenging payer policies that impede and hinder the day-to-day practice of otolaryngology-head and neck surgeons and engages payers to revise problematic or antiquated policies. We also develop practical resources to assist otolaryngologists-head and neck surgeons in obtaining appropriate and fair reimbursement for the services they provide their patients.

Given the ongoing administrative burden posed by private payers, state Medicaid plans, and Medicare, the following member-exclusive resources provide a comprehensive toolbox to help AAO-HNS members pursue fair reimbursement and deliver high-quality patient care.

Refine Your Coding with CPT for ENT

The Academy's Coding Corner makes accessing the newest coding and reimbursement tools simple and straightforward for members. Although individualized coding or billing advice is not provided, the CPT for ENT article series delivers regularly updated guidance on coding principles for commonly reported ENT procedures. Developed collaboratively by the Academy's CPT and RUC Advisors, the 3P Workgroup, and health policy staff, each article addresses a specific coding scenario through practical Q&As. These resources cover newly developed codes and changes to the AMA CPT code set and are compiled in a user-friendly library for physicians and their practices.

Strengthen Your Appeal Efforts with Template Letters

The Academy frequently hears from members who experience claim denials for commonly performed otolaryngology procedures. As a first line of defense when encountering a denied claim, the Academy strongly recommends that members take full advantage of payers' appeals processes. Although the AAO-HNS cannot intervene on behalf of individual members, the Academy maintains a suite of template appeal letters tailored to typical denial scenarios. These templates include fill-in-the-blank fields to reflect a physician's unique circumstances and outline recommended supporting documentation—such as medical records, operative notes, and Academy resources—to bolster appeal efforts.

Track Payer Engagement with the Private Payer Letters Library

The Academy's Health Policy Advocacy team actively engages with private insurers to advance the interests of the specialty and protect access to care. These efforts include advocating for policy changes, requesting updates to coverage criteria, and urging revisions to reimbursement policies. To keep members informed, the AAO-HNS maintains a comprehensive Private Payer Letters Library, which is regularly updated to reflect new payer outreach. By sharing these communications, the Academy equips members to align messaging and strengthen collective advocacy on behalf of the specialty.

Enhance Your Reimbursement Efforts with AAO-HNS Position Statements

The Academy maintains over 120 official AAO-HNS Position Statements, each representing a consensus recommendation, policy, or position on a specific topic. These statements are developed by Academy members or AAO-HNS/F committees and undergo approval by both the 3P Workgroup and the AAO-HNS/F Board of Directors' Executive Committee before adoption as official policy.

The Academy's Position Statements are not only a resource to support clinical decision-making and treatment—they are used by AAO-HNS members to justify accurate reimbursement for appropriate clinical care, by industry partners to argue for coverage decisions, and by the Academy's CPT and RUC teams to support new code creation and valuation. Members are encouraged to reference Position Statements to defend appeal arguments by providing direct quotes or attaching the document to an appeal letter. To learn more about the Position Statement development process, refer to this June 2024 Bulletin article.

Stay Up-to-Date on Coding Updates from CMS

The AAO-HNS actively engages with federal agencies to advocate for the interests of otolaryngologists and their patients. Each year, the Academy's Advocacy and Research & Quality teams carefully analyze regulations from the Centers for Medicare & Medicaid Services (CMS), including those related to the Medicare Physician Fee Schedule (MPFS) and the Quality Payment Program (QPP). The Academy also collects CMS data for commonly reported otolaryngology services and publishes an annual report listing the top 100 most utilized CPT codes. More information regarding the CY2026 MPFS/QPP proposed rules will be communicated to members as it becomes available.

Connect Directly with the Academy's Health Policy Advocacy Team

The Academy's health policy staff is available to assist members with questions related to payer policies and practice management. To stay up-to-date on recent coverage wins and related announcements, subscribe to the ENT Advocate—the Academy's monthly newsletter focused on developments in federal, state, and health policy advocacy. For assistance with national or local coverage issues, contact the Health Policy Advocacy team directly at healthpolicy@entnet.org.

Additional Health Policy Advocacy Resources:

Otolaryngology Workforce Report

Template Letter: Patient Notification

Template Letter: Claim Submission for an Unlisted Procedure